tbuckley/cabot-search huggingface dataset:
Medicare Beneficiaries’ Perspectives on the Quality of Hospital Care and Their Implications for Value-Based Payment
Authors: Logan Trenaman, Mark Harrison, Jeffrey S. Hoch
Journal: JAMA Network Open (2023)

Importance Medicare’s Hospital Value-Based Purchasing (HVBP) program adjusts hospital payments according to performance on 4 equally weighted quality domains: clinical outcomes, safety, patient experience, and efficiency. The assumption that performance on each domain is equally important may not reflect the preferences of Medicare beneficiaries. Objective To estimate the relative importance (ie, weight) of the 4 quality domains in the HVBP program from the perspective of Medicare beneficiaries and the impact of using beneficiary value weights on incentive payments for hospitals enrolled in fiscal year 2019. Design, Setting, and Participants An online survey was conducted in March 2022. A nationally representative sample of Medicare beneficiaries was recruited through Ipsos KnowledgePanel. Value weights were estimated using a discrete choice experiment that asked respondents to choose between 2 hospitals and indicate which they preferred. Hospitals were described using 6 attributes, including (1) clinical outcomes, (2) patient experience, (3) safety, (4) Medicare spending per patient, (5) distance, and (6) out-of-pocket cost. Data analysis was performed from April to November 2022. Main Outcomes and Measures An effects-coded mixed logit regression model was used to estimate the relative importance of quality domains. HVBP program performance was linked to Medicare payment data in the Medicare Inpatient Hospitals by Provider and Service data set and hospital characteristics from the American Hospital Association Annual Survey data set, and the estimated impact of using beneficiary value weights on hospital payments was estimated. Results A total of 1025 Medicare beneficiaries (518 women [51%]; 879 individuals [86%] aged ≥65 years; 717 White individuals [70%]) responded to the survey. A hospital’s performance on clinical outcomes was most highly valued by beneficiaries (49%), followed by safety (22%), patient experience (21%), and efficiency (8%). Nearly twice as many hospitals would see a payment reduction when using beneficiary value weights than would see an increase (1830 vs 922 hospitals); however, the average net decrease was smaller (mean [SD], −$46 978 [$71 211]; median [IQR], −$24 628 [−$53 507 to −$9562]) than the comparable increase (mean [SD], $93 243 [$190 654]; median [IQR], $35 358 [$9906 to $97 348]). Hospitals seeing a net reduction with beneficiary value weights were more likely to be smaller, lower volume, nonteaching, and non–safety-net hospitals located in more deprived areas that served less complex patients. Conclusions and Relevance This survey study of Medicare beneficiaries found that current HVBP program value weights do not reflect beneficiary preferences, suggesting that the use of beneficiary value weights may exacerbate disparities by rewarding larger, high-volume hospitals.
Assessment of Need for Improved Identification of a Culprit Drug in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
Authors: Dayan J. Li, Gustavo A. Velasquez, George A. Romar, Elisa M. Schunkert, Ruth K. Foreman, Sherrie J. Divito
Journal: JAMA Dermatology (2023)

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a severe hypersensitivity reaction. Identifying a culprit drug is critical for patient care, yet identification is based on clinical judgment. Data are limited on the accuracy in or approach to identifying a culprit drug.
Kiss of death between <scp>CAR‐T</scp> cells and <scp><i>KMT2a::AFF1</i></scp> B lymphoblasts in the central nervous system
Authors: Odile Fenneteau, Elodie Lainey
Journal: American Journal of Hematology (2023)

A 5-year-old boy diagnosed with a KMT2a::AFF1 pro-B acute lymphoblastic leukemia was infused with anti-CD19 tisagenlecleucel Chimeric Antigen Receptor T (CAR-T) cells for a central nervous system (CNS) relapse occurring 6 months after hematopoietic stem cell transplantation. Light microscopic examination of the cerebrospinal fluid (CSF) cytospin collected 5 days prior to infusion showed 88% lymphoblasts (CD19pos bright, CD22pos partial, CD20neg, CD10neg, CD34pos, NG2pos, CD133pos, CD135pos bright), 4% of T lymphocytes, and 8% monocytes. A lumbar puncture was repeated 7 days postinfusion due to clinical signs of neurotoxicity. The cell count was 134 leucocytes/μL with persistence of blasts (55%), increase in monocytes (37%), presence of activated basophilic lymphocytes with cytotoxic granules (9%) and rare basophils reflecting the inflammatory environment. The Day 7 flow cytometry analysis confirmed the persistence of CD19pos CD34pos blasts and showed that most of the lymphocytes (8%) were activated CAR-T cells (CD25bright, HLA-DRbright) distributed as follows: 13% CD4(+); 83% CD8(+) (Miltenyi Biotec® CD19 CAR detection reagent). Cytomorphology examination of the cytoslide showed very unusual images of CAR-T cells with large cytoplasmic extensions toward blasts illustrating immune synapses (×100; Image 1A). A Day 11 second CSF puncture (leucocytes: 204/μL) showed complete elimination of blasts with accumulation of macrophages/monocytes (55%) and lymphocytes/CAR-T (45%). Morphological examination revealed images of hemophagocytosis resulting from engulfment of apoptotic blasts (Image 1B). These pictures illustrate the sequential events (expansion, cytotoxicity, phagocytosis, and digestion) that lead to the elimination of CD19pos lymphoblasts by the "CAR-T cells/Macrophages" team in a pediatric relapsed B-ALL with active CNS involvement. Moreover, these photomicrographs also highlight how the peculiar morphology of CAR-T cells in the CSF (predominantly cytotoxic CD8(+)) can lead to potential confusion with lymphoblasts, especially in the case of blasts with cytoplasmic granulations, as in the case illustrated here. Adding CNS monitoring with flow cytometry may help to remove any doubt, in addition to allowing the quantification and follow the persistence of CAR-T cells. Elodie Lainey wrote the manuscript and Odile Fenneteau made the figure. All authors approved the final version of the manuscript. The authors are grateful to the family of our patient who gave full written consent for this publication and signed a research consent form at the time of treatment. The authors declare no conflicts of interest.
Comments on Study About Bariatric Surgery and Gastroesophageal Cancer—Reply
Authors: Andrea Lazzati, Caroline Gronnier, Tigran Poghosyan
Journal: JAMA Surgery (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Evidence Generation for Novel Cardiovascular Devices—Putting the Horse Back in Front of the Cart
Authors: David J. Cohen, Manesh R. Patel
Journal: JAMA Cardiology (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Cardiology HomeNew OnlineCurrent IssueFor Authors Podcast Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Cardiology journal
Omitted Author and Locations Where Trial Was Conducted
Journal: JAMA Surgery (2023)

Kai Zhang, MD; Jeremy Teoh, MD; Pilar Laguna, PhD, MD; Jose Dominguez-Escrig, MD; Eric Barret, MD; Juan Casanova Ramon-Borja, MD; Gordon Muir, MD; Julia Bohr, MD; Theo M. de Reijke, MD, PhD; Paula Pelechano Gómez, PhD, MD; Chi-Fai Ng, MD; Rafael Sanchez-Salas, MD; Jean de la Rosette, PhD, MD
High-definition Cathodal Direct Current Stimulation for Treatment of Acute Ischemic Stroke
Authors: Mersedeh Bahr-Hosseini, Kambiz Nael, Gozde Unal, Marco Iacoboni, David S. Liebeskind, Marom Bikson, Jeffrey L. Saver, Nerses Sanossian, Allan Wu, Bruce Dobkin, Gilda Avila
Journal: JAMA Network Open (2023)

Cathodal transcranial direct current stimulation (C-tDCS) provides neuroprotection in preclinical models of acute ischemic stroke (AIS) by inhibiting peri-infarct excitotoxic effects and enhancing collateral perfusion due to its vasodilatory properties.To report the first-in-human pilot study using individualized high-definition (HD) C-tDCS as a treatment of AIS.This randomized clinical trial was sham controlled with 3 + 3 dose escalation design, and was conducted at a single center from October 2018 to July 2021. Eligible participants were treated for AIS within 24 hours from onset, had imaging evidence of cortical ischemia with salvageable penumbra, and were ineligible for reperfusion therapies. HD C-tDCS electrode montage was selected for each patient to deliver the electric current to the ischemic region only. Patients were followed for 90 days.Primary outcomes were feasibility, assessed as time from randomization to study stimulation initiation; tolerability, assessed by rate of patients completing the full study stimulation period; and safety, assessed by rates of symptomatic intracranial hemorrhage at 24 hours. The efficacy imaging biomarkers of neuroprotection and collateral enhancement were explored.A total of 10 patients with AIS were enrolled, 7 were randomized to active treatment and 3 to sham. Patient age was mean (SD) 75 (10) years old, 6 (60%) were female, and National Institutes of Health Stroke Scale score was mean (SD) 8 (7). Two doses of HD C-tDCS (1 milliamp [mA] for 20 minutes and 2 mA for 20 minutes) were studied. The speed of HD C-tDCS implementation was a median (IQR) 12.5 minutes (9-15 minutes) in the last 4 patients. Patients tolerated the HD C-tDCS with no permanent stimulation cessation. The hypoperfused region was reduced by a median (IQR) 100% (46% to 100%) in the active group vs increased by 325% (112% to 412%) in sham. Change in quantitative relative cerebral blood volume early poststimulation was a median (IQR) 64% (40% to 110%) in active vs -4% (-7% to 1%) sham patients and followed a dose-response pattern. Penumbral salvage in the active C-tDCS group was median (IQR) 66% (29% to 80.5%) vs 0% (IQR 0% to 0%) in sham.In this randomized, first-in-human clinical trial, HD C-tDCS was started efficiently and well tolerated in emergency settings, with signals of beneficial effect upon penumbral salvage. These results support advancing HD C-tDCS to larger trials.ClinicalTrials.gov Identifier: NCT03574038.
Proportion of Nursing Home Residents With Dementia Affects Their Care
Authors: Emily Harris
Journal: JAMA (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Hush Little Baby — Promise of the Eat, Sleep, Console Approach
Authors: Wanda D. Barfield
Journal: New England Journal of Medicine (2023)

"Hush little baby, don't say a word …" This traditional lullaby is symbolic of our attempts to offer an appropriate intervention for infants with neonatal opioid withdrawal syndrome. The incidence of this condition, which affects newborns after maternal opioid exposure during pregnancy, has increased substantially in recent years,1 and more holistic approaches are being sought to support the care of mother, infant, family, and community.2 In this issue of the Journal, Young et al.3 report the results of a large trial assessing a nonpharmacologic strategy — the Eat, Sleep, Console approach — for the treatment of neonatal opioid withdrawal syndrome. . . .
3-Year Outcome in Patients With Combined Precapillary and Postcapillary Pulmonary Hypertension
Authors: Hang Zhang, Jing Kan, Juan Zhang, Dujiang Xie, Xiaobo Li, Wenying Zhou, Jianzeng Dong, Hong Gu, Yaling Han, Shao-Liang Chen
Journal: JACC Heart Failure (2023)
Outcomes from a national screening program for Ukrainian refugees at risk of drug resistant tuberculosis in Wales
Authors: Simon M Barry, Gareth Davies, Tamas D Barry, Jennifer Evans, Matthijs Backx, Mattheus Brouns, Ahsan Mughal, Stephen Kelly, Gareth Collier, Sakkarai Ambalavanan, Chris Davies, Hannah Sharp, Pam Lloyd, Yvonne Hester, Natalie Murray, Kelly Goddard, Linzi Johnstone, Jane Parry, Olwen Davies, Rhian Williams, George Ahern, Josie Smith
Journal: Thorax (2023)

High rates of drug-resistant tuberculosis in Ukraine suggest screening is necessary to mitigate public health hazards for host populations. A pathway was implemented in Wales and data prospectively collected Between 8 April and 21 December 2022. Of 5425 Ukrainian arrivals, notifications were received by TB teams on 2395 (44%) of whom 1955 (82%) were screened. The refugees were young (median age 30, IQR 14–41), and predominantly female (66.1%). Interferon- gamma release assay (IGRA) tests were positive in 112 (6.5%). One Case of active tuberculosis was identified (0.05%). Our data supports European guidelines that routine screening of this population is not recommended, but we remain uncertain as to the risks of this population going forwards.
Metabolic rewiring controlled by c-Fos governs cartilage integrity in osteoarthritis
Authors: Kazuhiko Matsuoka, Latifa Bakiri, Martin Bilban, Stefan Toegel, Arvand Haschemi, Hao Yuan, Maria Kasper, Reinhard Windhager, Erwin F Wagner
Journal: Annals of the Rheumatic Diseases (2023)

The activator protein-1 (AP-1) transcription factor component c-Fos regulates chondrocyte proliferation and differentiation, but its involvement in osteoarthritis (OA) has not been functionally assessed.c-Fos expression was evaluated by immunohistochemistry on articular cartilage sections from patients with OA and mice subjected to the destabilisation of the medial meniscus (DMM) model of OA. Cartilage-specific c-Fos knockout (c-FosΔCh) mice were generated by crossing c-fosfl/fl to Col2a1-CreERT mice. Articular cartilage was evaluated by histology, immunohistochemistry, RNA sequencing (RNA-seq), quantitative reverse transcription PCR (qRT-PCR) and in situ metabolic enzyme assays. The effect of dichloroacetic acid (DCA), an inhibitor of pyruvate dehydrogenase kinase (Pdk), was assessed in c-FosΔCh mice subjected to DMM.FOS-positive chondrocytes were increased in human and murine OA cartilage during disease progression. Compared with c-FosWT mice, c-FosΔCh mice exhibited exacerbated DMM-induced cartilage destruction. Chondrocytes lacking c-Fos proliferate less, have shorter collagen fibres and reduced cartilage matrix. Comparative RNA-seq revealed a prominent anaerobic glycolysis gene expression signature. Consistently decreased pyruvate dehydrogenase (Pdh) and elevated lactate dehydrogenase (Ldh) enzymatic activities were measured in situ, which are likely due to higher expression of hypoxia-inducible factor-1α, Ldha, and Pdk1 in chondrocytes. In vivo treatment of c-FosΔCh mice with DCA restored Pdh/Ldh activity, chondrocyte proliferation, collagen biosynthesis and decreased cartilage damage after DMM, thereby reverting the deleterious effects of c-Fos inactivation.c-Fos modulates cellular bioenergetics in chondrocytes by balancing pyruvate flux between anaerobic glycolysis and the tricarboxylic acid cycle in response to OA signals. We identify a novel metabolic adaptation of chondrocytes controlled by c-Fos-containing AP-1 dimers that could be therapeutically relevant.
Defensive medicine is a driver of overmedicalisation
Authors: Akanksha Thumbe
Journal: BMJ (2023)

Defensive medicine is a driver of overmedicalisation Akanksha Thumbe clinical teaching fellowMathew makes several excellent points on the need for political policies to tackle overmedicalisation, 1 but an important factor not mentioned is defensive medicine.The fear of litigation or receiving a complaint because of inaction or deviation from guidelines is an uncomfortable element in many clinicians' decision making. 2 I have often heard the phrase, "It is better to be safe than sorry," in healthcare settings, from both patients and staff.But in cases of over-intervention, this does not acknowledge the potential risks to the patient.Incidental findings on scans or blood tests might require further investigation, which can cause a great deal of anxiety, not to mention the physical risks associated with repeated exposure to radiation and invasive testing that a patient might experience.By trying to avoid a poor outcome by over-investigating or over-prescribing, we might be inadvertently harming our patients.Dealing with uncertainty requires shared decision making, trust, and time to manage patient expectations and to make good use of the resources available.But the way in which the system deals with errors also needs to change if doctors are to move away from defensive practice.
Radiomics of Late Gadolinium Enhancement Reveals Prognostic Value of Myocardial Scar Heterogeneity in Hypertrophic Cardiomyopathy
Authors: Ahmed S. Fahmy, Ethan J. Rowin, Narjes Jaafar, Raymond H. Chan, Jennifer Rodriguez, Shiro Nakamori, Long H. Ngo, Silvia Pradella, Chiara Zocchi, Iacopo Olivotto, Warren J. Manning, Martin Maron, Reza Nezafat
Journal: JACC. Cardiovascular imaging (2023)
The deadly legacy of a stem cell charlatan
Authors: John E J Rasko, Carl Power
Journal: BMJ (2023)

Paolo Macchiarini misled the world over his breakthroughs in regenerative medicine, but why did most of the institutions that supported him bear no responsibility for hosting a rogue stem cell surgeon? It’s time for them to launch full and independent investigations, argue <b>John Rasko</b> and <b>Carl Power</b>
Amantadine for COVID-19 treatment (ACT) study: a randomized, double-blinded, placebo-controlled clinical trial
Authors: Nina Weis, Signe Bollerup, Jon Dissing Sund, Jakob Borg Glamann, Caroline Vinten, Louise Riger Jensen, Christoffer Sejling, Thomas Nitschke Kledal, Mette Marie Rosenkilde
Journal: Clinical Microbiology and Infection (2023)

ObjectivesThe COVID-19 pandemic has revealed a severe need for effective antiviral treatment. The objectives of this study were to assess if preemptive treatment with amantadine for COVID-19 in non-hospitalized persons ≥40 years or adults with comorbidities was able to prevent disease progression and hospitalization. Primary outcomes were clinical status on day 14.MethodsBetween 9th June 2021 and 27th January 2022, this randomized, double-blinded, placebo-controlled, single-center clinical trial included 242 subjects with a follow-up period of 90 days. Subjects were randomized 1:1 to either amantadine 100 mg or placebo twice daily for five days. The inclusion criteria were confirmed SARS-CoV-2 infection and at least one of (i) age ≥ 40 years, age ≥ 18 years (ii) and at least one comorbidity, or - (iii) and BMI ≥ 30. The study protocol was published at www.clinicaltrials.gov (unique protocol #02032021) and at www.clinicaltrialregister.eu (EudraCT-number 2021-001177-22).ResultsWith 121 participants in each arm, we found no difference in the primary endpoint with 82 participants in the amantadine arm, and 92 participants in the placebo arm with no limitations to activities, respectively, and 25 and 37 with limitations to activities in the amantadine arm and the placebo arm respectively. No participants in either group were admitted to hospital or died. The Odds Ratio of having state severity increased by 1 in the amantadine group versus placebo was 1.8 (Confidence Interval 1.0-3.3, (p=0.051)). At day 7, one participant was hospitalized in each group; throughout the study this increased to five and three participants for amantadine versus placebo treatment (P=0.72). Similarly, at day 7, there was no difference in the status of oropharyngeal swabs. Most participants (108 in each group) were SARS-CoV-2 RNA positive (p=0.84).ConclusionsWe found no effect of amantadine on disease progression of SARS-CoV-2 infection.